Jennifer Handy

General
21 May 2019 Medical
Our ref:1-11DBAB6 Council

3 Hardman Street
Manchester M3 3AW

Email: gmc@gme-uk.org

Website: www.gme-uk.org

Telephone: 0161 923 6602

Private: for addressee only Fax: 0161 923 6201

Miss Rachel Knight
Assistant Coroner
Coroner’s Office
The Old Courthouse
Courthouse Street
Pontypridd

CF37 13Q

Dear Miss Knight
Jennifer Louise Handy (deceased)

Thank you for your letter of 8 April 2019. I have reviewed the Regulation 28 Report
of 5 April 2019, as well as the background of this case, and am responding on
behalf of the GMC in my role as Head of the Corporate Review Team.

The GMC’s statutory function

By way of background, it would be helpful to first clarify the scope of the GMC’s
statutory powers.

The GMC’s role and statutory powers and duties are defined principally in the
Medical Act 1983 (‘the Act’).

The GMC's functions derive from the statutory requirement for the establishment
and maintenance of the Medica! Register (the Register’), setting professional
standards for, overseeing the education and training of, and investigating and
acting on concerns about doctors.

These powers and duties only extend to doctors who hold GMC registration (with
or without a licence to practise). This remains the case even if a doctor is practising
outside of the UK.

The GMC is a charity registered in.

Working with doctors Working for patients England and Wstes (1089278)

anid Scotland (5C037750)

Response to Regulation 28 Report

I will address each of the points in the Regulation 28 Report in turn.

You may wish to consider the recording of, updating of and accuracy of
contact details for doctors who are licenced to work in the UK, especially
if they are from overseas and may travel around for work in different
countries.

The Act already makes provision for the GMC to take action on a doctor’s
registration for failing to maintain an effective registered address.

Under section 30(5) of the Act the GMC is entitled to make enquiries of a doctor to
request they provide an up-to-date address where they can be contacted. This
ensures that the GMC always has an effective method of contact.

If the doctor fails to keep their registered address up to date the GMC has the
power to erase them from the Register.

As previously stated, the provisions of the Act apply to all doctors registered with
the GMC, whether they work/live in the UK or overseas.

Action: For the reasons set out above, we do not consider that any action is
required to address this point.

There should be a legal/ contractual requirement of doctors who leave
this jurisdiction to provide personal contact details for a period of time
post-departure, and to ensure the same remain updated.

In order to address this point it is important to understand the legal basis of the
GMC's powers and how these apply to its registrants i.e. doctors.

The GMC is a statutory body whose functions are derived from statute. In its
function as a regulator, the GMC's relationship with its registrants is governed by
statute which includes various legislation and through professional standards which
it sets.

As such, the legal requirements on doctors arise from legislation and professional
standards documents produced by the GMC. There is no contractual relationship
between the GMC and the registrant.

You have suggested that there should be a legal requirement of doctors to provide
contact details for a period of time ‘post-departure’. It is not clear to me whether
this means 1) after the doctor has been erased from the Register or 2) after they
have left the UK (but are still registered with the GMC). As such, I will confirm the
position in respect of both interpretations.

The GMC fs a charity registered in

Working with doctors Working for patients England and Weles (1089278)

and Seotiand (5C037750)

In terms of the first interpretation, the GMC’s statutory powers extend only to
doctors who hold GMC registration. As such, there is no legal basis to require
doctors to provide their contact details to the GMC once their registration has
ended.

However, it is not the case that a doctor can simply remove themselves from the
Register in all circumstances. It is unlikely that a doctor seeking voluntary erasure
from the Register would be successful in their application if there are outstanding
fitness to practise concerns and there are reasonable grounds that the doctor’s
fitness to practise may be impaired.

Regarding doctors who leave the UK, the provisions of the Act apply to all doctors
registered with the GMC, whether they work/live in the UK or overseas, and the Act
already makes provision for the GMC to take action on a doctor’s registration for
failing to maintain an effective registered address.

Action: For the reasons set out above, we do not consider that any action is
required to address this point.

There should be a legal/contractual requirement of doctors who leave
this jurisdiction to comply with reasonable requests of
investigators/coroners to provide evidence.

As explained above, the legal and professional requirements of doctors arise from
legislation and professional standards documents produced by the GMC, as
opposed to there being any contractual relationship between the parties.

The provisions of the Act, as well as other relevant legislation and statutory
guidance, apply to all doctors registered with the GMC, whether they work/live in
the UK or overseas.

There are provisions in the GMC’s main guidance document in relation to a doctor's
professional obligation to assist with formal proceedings.

This guidance is called Good Medical Practice (GMP’) and this outlines the standard
of professional conduct that the public expects from its doctors and provides
principles that underpin the GMC’s fitness to practise decisions.

Specifically, paragraph 73 of GMP sets out the requirement that doctors ‘must
cooperate with formal inquiries and complaints procedures and must offer alf
relevant information while following the guidance in Confidentiality’,

Serious and persistent failures to follow GMP may result in fitness to practise
proceedings which could put a doctor's registration at risk.

The GMC is a charity registered in.

Working with doctors Working for patients England and Wates (1089278

and Scotland (5C037750}

The standards of conduct that GMC registered doctors are required to follow are
the same whether the doctor lives and/or works in the UK or out of this
jurisdiction.

To clarify, under the legislative framework there is no legal basis to compel a
doctor to engage in coroner's proceedings, although as explained above there is a
professional duty to cooperate with inquiries under GMP.

It is of course open to the Coroner to summons a doctor to attend a coroner's
inquest to give evidence, in which case a doctor must attend or be in contempt of
court.

In the event that a GMC registered doctor is convicted of contempt of court, the
conviction can be a ground of impaired fitness to practise and this may result in
fitness to practise proceedings.

Action: For the reasons set out above, we do not consider that any action is
required to address this point.

Every doctor who leaves this jurisdiction to work overseas should
provide the name of every country they practice in thereafter, together
with the contact details of the relevant regulatory body (akin to the
GMC) for those countries.

There are already mechanisms in place for overseas regulators to share information
regarding disciplinary action or criminal sanctions in relation to doctors working
other jurisdictions.

Under the provisions of the European Directive’, the member states of the
European Union are under an obligation to exchange information regarding
disciplinary action and criminal sanctions taken against doctors. This is done via the
Internal Market Information System which is an online tool that facilitates the
exchange of information between public authorities.

There is also a mechanism for international medical regulators to share information
for the purpose of promoting effective medical regulation worldwide via
membership of the International Association of Medical Regulation Authorities
CIAMRA’.

JAMRA enables the sharing of fitness to practise/disciplinary information among
IAMRA members.

* Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005

The GMC is a charity registered in

Working with doctors Working for patients England and Weles (1089278)

and Scotland (5C037750)

The IAMRA statement of intent on proactive information sharing describes the
circumstances in which information shall be shared between medical regulatory
authorities. This includes where a:

- doctor's right to practice has been restricted or removed because of matters
relating to his conduct, health, performance, or matters of a criminal nature;
and/or

- where a medical regulatory authority has objective reasons to believe that
identity or document fraud has been used, or may be used in the future, by
a doctor, either to avoid restrictions on his practice or to obtain registration
falsely in another country.

It is also standard practice for regulators to share information using certificates of
good standing when a doctor has been working in one jurisdiction but has applied
to work in another. A certificate of good standing shows the details of a doctor's
current registration and licence status; their registration and fitness to practise
history; identifying information; and whether there are fitness to practise
proceedings in progress or contemplated. If a doctor applied to work in the UK
after practising in another jurisdiction, they would need to provide a certificate of
good standing from the relevant regulators to demonstrate that they are fit to
practise,

In addition, GMC guidance also sets a requirement for doctors to disclose relevant
disciplinary information to the GMC. Specifically, paragraph 75 of GMP states

that...‘ You must tell us without delay if, anywhere in the world another professional
body has made a finding against your registration as a result of fitness to practise
procedures.’

As explained above, serious failures to follow GMP may result in fitness to practise
proceedings which could put a doctor's registration at risk.

It is our position that the above mechanisms offer sufficient protection of patient
safety in the circumstance that a doctor is the subject to fitness to practise
proceedings in another jurisdiction.

Action: For the reasons set out above, we do not consider that any action is
required to address this point.

Consider whether a register akin to the Criminal Records Bureau should
be established to flag up matters of concern with doctors, so that
prospective employers could identify any issues of clinical governance
that have arisen.

There are currently systems in place so that employers can access information
about matters relating to a doctor's fitness to practise.

The GMC is a charity registered in

Working with doctors Working for patients England and Wales (1089278)

and Scotland ($C0377S0)

Information about a doctor's fitness to practise history (including details of whether
there are any restrictions on a doctor's registration) can be publicly accessed on an
online register, the List of Registered Medical Practitioners (LRMP’). It is
recommended that employers check a doctor’s entry on LRMP as part of their
recruitment processes.

Action: For the reasons set out above, we do not consider that any action is
required to address this point.

Conclusion

Thank you for your report and recommendations. I hope that we have addressed
the issues raised and satisfactorily explained why no further action is required.

In summary:

- the GMC’s statutory powers and duties only extend to doctors who are
registered with the GMC (in the UK or overseas);

— the Act makes provision to erase doctors who fail to maintain an effective
registered address;

- _ the legal and professional requirements of doctors arise from legislation and
professional standards set by the GMC, as opposed to there being any
contractual relationship between the parties;

- _ international regulators already have data sharing practices in place;

- _ information about a doctor's fitness to practise history can be publicly
accessed on the online register, LRMP.

Yours sincerely

ai

Head of Corporate Review Team
E mail

The GMC is a charity registered im

Working with doctors Working for patients England and Weles (1089278)

and Scotland (SCO37750}

Your Ref/eich cyf: 
Our Ref/ein cyf: 
Date/dyddiad: 
Tel/ffon: 
Fax/FFacs: 
Email/ebost: 
Dept/adran: 

RK/JH/Reg28 
17/2553/INQ 
17 May 2019 

Patient Care & Safety 

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University Health Board 

Private & Confidential 
Miss Rachel Knight 
Her Majesty's Coroner 
Pontypridd Coroners Court 
Court House Street 
Pontypridd 
CF37 lJW 

Dear Miss Knight 

RE: Regulation 28 - Jennifer Handy 

Thank you for the correspondence in relation to the above Regulation 28 received on 10th 
April 2019, which details the areas of concern following the conclusion of the inquest held 4 
April 2019. 

Please be assured that the Health Board has taken this matter extremely seriously, has learnt 
lessons following investigation and the matters raised at the inquest into the circumstances. 
Comprehensive and robust action has been taken to minimise the risk of any recurrence. 

Actions: 
A timeline has been  prepared which  includes the involvement surrounding the inquest of 
Legal and Risk Services, Claims Team and Coroner's Officer. 

The timeline demonstrates that details for the Registrar were obtained by a Consultant in 
Obstetrics and forwarded to Legal and Risk Services, who in turn contacted the Registrar on 
numerous occasions and communication was made.  The Registrar stopped responding to 
Legal and Risk, the Coroner's Officer was advised and provided with the email address of the 
Registrar. 

Learning for the Health Board 
The Claims Team were unaware there was an investigation by the GMC, that the Registrar 
had surrendered his license to practice, and he had relocated to Sri  Lanka. From here on, if 
a doctor has left the Health Board, contact will  be made with the Assistant Medical  Director 
for  Professional  Regulation  and  Standards  to  establish  whether there  are  any ongoing 
concerns/issues in relation to the GMC. 

Return Address: Cwm Taf University Health Board, Headquarters, Navigation Park, Abercynon, CF45 
4SN 

Chair/ Cadeirydd; Professor Marcus Longley 

Chief Executive/ Prif Weithredydd:  Mrs A Williams 

Cwm Taf University Health Board is the operational name of the Cwm Taf University Health Board/Bwrdd lechyd Prifysgol Cwm Taf yw enw gweithredol 
Bwrdd lechyd Prifysgol Cwm Taf 

 
 
 
 I sincerely  hope  that this  information  will  reassure  you  that the  Health  Board  has  learnt 
important lessons from the investigation into the care provided to Mrs Handy and that effective 
action has now been taken to prevent further deaths. 

I would like to convey once again my deepest sympathy and sincere apologies to Mr and Mrs 
Handy for the failings identified. 

Yours sincerely 

M~ms 
Chief Executive Officer 

Enc 

Return Address: Cwm Taf University Health Board, Headquarters, Navigation Park, Abercynon, CF45 
4SN 

Chair/ Cadeirydd; Professor Marcus Longley 

Chief Executive/ Prif Weithredydd: Mrs A Williams 

Cwm Taf University Health Board is the operational name of the Cwm Taf University Health Board/Bwrdd lechyd Prifysgol Cwm Taf yw enw gweithredol 
Bwrdd lechyd Prifysgol Cwm Taf